Eyeball Tattoo Goes Sideways | MedPage Today

Eyeball tattoos can carry risk of adverse events that usually occur within weeks, but one patient didn’t have problems until 8 years later.

The patient had their conjunctiva tattooed so the white part of the eye would look black. But after a swim in the Mediterranean while on vacation, they developed irritation in the right eye that felt “like a scratch on the eye,” Zain Amir, MBChB, of the Moorfields Eye Hospital in London, and colleagues wrote in BMJ Case Reports.

Ocular and periocular tattooing has had a rise in popularity globally, according to a recent review article in the journal Diagnostics. There are many reasons for this, including that people may want to look like movie characters or comic heroes, dyeing their eyeballs with a variety of colors such as, black, green, or red.

Some reports documented a flurry of such cases among people who dyed their eyes blue to resemble characters in the science fiction movie Dune. There was also the case of Canadian model Cat Gallinger who dyed her eyes purple but nearly went blind doing so.

For this case, further investigation of the right eye revealed uneven distribution of the para-corneal tattoo pigment, which had accumulated at the nasal conjunctiva, they reported. Pigment distribution in the left eye was evenly distributed.

Amir and team ultimately diagnosed the patient with corneal dellen formation as a complication of conjunctival tattooing — the first such instance of it, they said.

“This is a novel presentation of ocular surface disease elicited from such practices which differs from previous documented cases of post-ocular tattooing complications,” they wrote.

The doctors prescribed a long-term course of topical oculentum carbomer 0.25% gel and guttae sodium hyaluronate 0.15% with trehalose 3% drop lubricants.

Two months later, the patient had stopped the lubricants, and the symptoms had returned — so physicians encouraged good compliance and longer-term use of the treatments.

It’s not clear why the patient’s symptoms developed 8 years after the tattoos, and how a swim in the sea could have contributed to them, the authors wrote.

“The patient is clear regarding symptoms starting following their exposure to sea water,” the authors wrote. “This interaction causing a pro-inflammatory conjunctivitis leading to pigmentation redistribution is possible but would require further research to provide a causal link.”

Patients who opt for conjunctival tattooing “should be alerted that the irreversible pigment deposition can manifest as unexpected long-term complications,” they concluded.

Natalie Afshari, MD, chief of cornea and refractive surgery at the University of California San Diego’s Shiley Eye Institute, said cases like this are extremely rare, but sometimes professional tattooing of the eye has a legitimate purpose — for example, in patients whose corneal blindness in one eye causes it to look white. Corneal tattooing can make both eyes look the same.

Contact lenses, if blind patients can tolerate them, can accomplish the same thing, and are reversible, whereas tattooing in the eye is permanent, she said.

But if patients want to tattoo their eyes simply to look strange, or resemble a comic book character, she wouldn’t do it because of the risk that the ink can cause infection, inflammation, and mask other eye diseases, like melanoma, “and can even cause glaucoma in rare cases,” she said. “Tattoo ink is not intended to be underneath the conjunctiva.”